- Cleveland Clinic (Weston, FL)
- …world. As Clinical Risk Manager I, you will direct the Clinical Risk Management Program and implement initiatives to ensure operational alignment with ... objectives. You will develop leading investigations, manage and analyze data and establish risk management educational programs for assigned areas. Serving as a… more
- Molina Healthcare (St. Petersburg, FL)
- …Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment ... to evaluate healthcare intervention program performance. Develops and presents Risk Adjustment intervention ROI, incremental conditions captured, and other program… more
- Evolent (Tallahassee, FL)
- …Adjustment coding team members, including coding support specialists. + Provides leadership, management , and ongoing training to Risk Adjustment coding support ... Coding Support Specialist** Evolent Care Partners is seeking a Risk Adjustment Coding Support Manager to be a core...and direction as appropriate. + Responsible for ongoing performance management of assigned direct reports. + Serves as a… more
- Molina Healthcare (Orlando, FL)
- …Condition Categories) Risk Adjustment Model + Background in supporting risk adjustment management activities and clinical informatics + Experience with ... codes are reported accurately to maintain compliance and to minimize risk and denials. **KNOWLEDGE/SKILLS/ABILITIES** + Performs on-going chart reviews and abstracts… more
- The Hartford (Lake Mary, FL)
- …its business partners and agents through timely delivery of industry leading safety and risk management solutions. This role will have a Remote work arrangement, ... and needs, make recommendations that will assist the insured's management to correct and prevent the potential for future...process - meeting with insured's, making presentations, working with claims and underwriting, etc. + Work with Risk… more
- Molina Healthcare (St. Petersburg, FL)
- …Strong Knowledge of Performance Indicators: + Experience developing queries within project management tools like Azure DevOps. + Risk Adjustment experience and ... **Job Summary** This Sr. Analyst, Healthcare Analytics role will support Molina's Risk Adjustment Analytics team. The job responsibilities include developing risk… more
- AdventHealth (Maitland, FL)
- …Manages Quality and Risk and understands and applies quality assurance and risk management procedures in all areas of work performed Identifies and solves ... Risk and understands and applies quality assurance and risk management procedures in all areas of...provider types Managed Care, Patient Financial services, health insurance claims processing, contract management , or medical economics… more
- Carnival Cruise Line (Miami, FL)
- …fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management ** + Review crew cases of high risk and escalate to the ... compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return...attention of risk management and the case management (MD), clinical… more
- Sedgwick (Orlando, FL)
- …or college preferred. **Experience** Three (3) years of benefits or disability case/ claims management experience or equivalent combination of education and ... FL 32826 **PRIMARY PURPOSE** : To provide disability case management and claim determinations based on complex medical documentation...this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps… more
- Sedgwick (Orlando, FL)
- …on state regulations. **Experience** Three (3) years of benefits or disability case/ claims management experience or equivalent combination of education and ... the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more